精神分裂症患者病程与家属心理健康状况调查分析

目的探讨精神分裂症患者病程与家属心理健康状况的相关性,为促进患者家属心理健康和培养良好应对方式提供科学依据。方法采用随机抽样的方法,选取360名精神分裂症患者家属,按患者病程的长短将患者家属分为首发患者家属组（A组）、5年以下病程患者家属组（B组）、5年及以上病程患者家属组（C组）3组,通过调查法、症状自评量表（SCL-90）和Bradburn编制情感量表对3组患者家属心理健康状况进行调查分析。结果3组SCL-90量表总分及各因子分均高于国内常模（P〈0．05）,A组SCL-90量表除敌对和偏执外其他各因子分及总分均高于B组（P〈0．05）,除焦虑、敌对、偏执外其他各因子分及总分均高于C组（P〈0．01）,B组躯体化、强迫、抑郁、恐怖因子分高于C组（P〈0．05）。A组在正性情感、负性情感、情感平衡3个维度上均显著低于B组、C组（P〈0．01）。结论精神分裂症患者家属普遍存在心理健康问题,且不同病程的患者家属存在的心理问题不尽相同,而随着病程迁延,家属的心理调节能力逐渐增强,心理满意程度渐趋稳定。     

Symptoms and social adjustment of schizophrenic patients as evaluated by family members

The purpose of this study is to reveal the relationship between family expressed emotion (EE) and family evaluation for symptoms and social adjustment of schizophrenic patients. Chronic schizophrenic outpatients in offshore islands under stationary therapeutic conditions were studied. For evaluation, the Five Minute Speech Sample (FMSS) for EE and the Katz Adjustment Scale (KAS) for family evaluation of patients were used. EE level was high among relatives who thought the patient was belligerent, negativistic, unstable or helpless. High-EE relatives tended to evaluate their patients' performance of social activities rather low and showed strong dissatisfaction with the patient's leisure activities. Moreover, a high emotional overinvolvement (EOI) value is more common in Japan than in other countries. A subgroup of the FMSS-EOI, the emotional display, was seen where many mothers began to cry while speaking.     

A study of the family burden of 150 family members of schizophrenic patients.

PURPOSE: Investigation into the family burden (FB) of schizophrenic patients has recently risen sharply. Nevertheless, to date there has been little consensus as to what factors influence the FB. The purpose of this study is to acquire a greater insight into the variables that influence the FB. SUBJECTS/METHODS: The FB was measured with the interview for the family burden (Kluiter H, Kramer JJAM, Wiersma D, et al. Interview voor de belasting van de familie 1997 [Interview for the burden on the family]. Department Sociale Psychiatrie. Groningen: Rijksuniversiteit). One hundred and fifty family members (parents/partners) of schizophrenic patients participated in the study. RESULTS: The results of our study show (1) that family members experience burden both on a practical and an emotional level, (2) a highly significant correlation between the amount of symptomatic behaviour of the patient and FB, (3) that parents had taken on more tasks, had contributed more financially and had experienced a tenser atmosphere at home than partners did and (4) that family members of patients who have been treated for less than 1 year worry more about the other members of their family than family members of patients who have been receiving treatment for more than 1 year. CONCLUSIONS: Family members of schizophrenic patients experience burden on a practical, financial and emotional level and the extent of the burden is closely linked to the amount of symptomatic behaviour of the patient.     

Impact of demented patients on their family members and care-givers in Taiwan

A standardized questionnaire was sent to family members or care-givers of 105 patients with dementia; 68 were returned. Eighty-eight percent of the patients were cared for at home by their spouses or adult children. The adverse impacts of dementia on patient family's economy, relations among family members, and social life are recognized. The majority of the subjects had only limited understanding of dementia. Having medical insurance helps the family in caring for the demented patients, emotionally and socially, but not financially. A better social welfare system, as well as health insurance, is recommended.     

精神分裂症患者乙型肝炎病毒感染调查

目的:调查精神分裂症患者的乙型肝炎病毒(HBV)感染与肝功能异常情况。方法:对312例精神分裂症住院患者的HBV感染及丙氨酸氨基转移酶(ALT)异常进行流行病学调查,以健康体检者279名为对照。结果:精神分裂症患者的HBV感染率为71.8%,ALT异常率为29.5%,明显高于对照组,精神分裂症患者中两性间HBsAg阳性率以男性显著较高。再次住院患者的HBV感染显著比首次住院患者高。结论:对精神分裂症患者应加强隔离措施,特别是HBsAg阳性的患者,防止交叉感染;加强健康教育,加强饮食营养支持和乙肝疫苗的接种等措施。     

重庆地区抑郁症患者博尔纳病病毒感染的分子生物学研究

背景博尔纳病病毒(Borna disease virus,BDV)是一种高度嗜神经的RNA病毒,是人畜共患病博尔纳病(Borna disease,BD)的病原体,可引起从鸟到灵长类的多种动物的中枢神经系统感染[1],表现为以中枢神经系统功能障碍为特征的BD。近年研究发现BDV感染与一些神经精神疾病的发病有关,尤其是精神疾病。但有关BDV感染与抑郁症(depressive disorder,DD)发病之间的关系,目前国内外研究尚有争议。本研究从分子生物学角度进一步探讨BDV与DD发病之间的关系。方法采用巢式逆转录酶聚合酶链反应(nRT-PCR)结合荧光定量聚合酶链反应(FQ-PCR)检测了60例DD患者和120名健康人外周血单个核细胞(PBMCs)中BDV p24基因片段,对FQ-PCR阳性产物进行克隆和基因序列测定,测序结果与人和动物来源的BDV分离株以及标准株Strain V和He/80进行序列比较。对两组阳性率进行Fisher精确概率检验。结果DD组BDV p24基因片段阳性率为5%(3/60);健康组阳性率为0%(0/120)。DD组阳性率高于健康组,差异有显著性意义(P<0·05)。测序结果为5′-CCCTCCAAGTGGAAACCATCCAGACAGCTCAGCGGTGCGACCACTCCGACAGCATCAGGATTCTTGGCGAGAACATCAA-GATACTG-3′。登陆美国国家生物技术信息中心,证实所获得目的基因片段确系BDV p24基因片断,与人类基因组片段和其他病毒基因组片段无同源性。其与马源的BDV病毒株H1766序列比较亲缘关系最近,同源性为97.68%,在2个位点出现突变(nt1675T→C,nt1678C→T)。与其他国际公认的标准病毒株Strain V和He/80比较,同源性分别为96·51%和95·.35%,碱基互换中局限于T-C、和A→G两种。结论中国的DD患者中存在BDV感染,重庆地区DD的发病可能与BDV感染有关。     

Multiple perspectives on mental health outcome: needs for care and service satisfaction assessed by staff, patients and family members

Purpose

Community-based mental health care requires the involvement of staff, patients, and their family members when both planning intervention programmes and evaluating mental health outcomes. The present study aimed to compare the perceptions of these three groups on two important subjective mental health outcome measures—needs for care and service satisfaction—to identify potential areas of discrepancy.

Methods

The sample consisted of patients with a DSM diagnosis of psychosis and attending either outpatient or day centres operating in a community-based care system. Staff, patients and family members were assessed by using the CAN and the VSSS to evaluate, respectively, needs for care and service satisfaction. Kappa statistics were computed to assess agreement in the three groups.

Results

Patients identified significantly fewer basic (e.g. daytime activities, food, accommodation) and functioning needs (e.g. self-care, looking after home, etc.) than staff or family members. Only fair levels of agreement were found in the three groups (average kappa was 0.48 for staff and patients, 0.54 for staff and family members, and 0.45 for patients and relatives), with patients and family members showing more areas of discrepancies in both needs and service satisfaction.

Conclusions

These findings provide further support for the idea that mental health services should routinely involve patients and their relatives when planning and evaluating psychiatric intervention and that this policy is a premise for developing a partnership care model.     

精神分裂症患者亲属应对方式、心理健康状况及健康教育需求的研究

目的探讨精神分裂症患者亲属应对方式、心理健康状况及其相关性以及健康教育需求情况。方法应用特质应对方式问卷、症状自评量表(SCL-90)、自制健康知识知晓情况及健康教育需求情况调查表对100名精神分裂症患者亲属进行调查。结果精神分裂症患者亲属积极应对因子分低于常模,消极应对因子分高于常模,其SCL-90总分及各因子分均高于常模,差异有显著性(P<0.05或0.01),相关分析表明,精神分裂症患者亲属SCL-90躯体化、敌对因子分与积极应对分呈显著负相关(P<0.05),SCL-90总分、强迫、人际关系、抑郁、焦虑、敌对、恐怖、偏执、精神病性因子分与消极应对分呈显著正相关。97%的患者亲属知道疾病的诊断,但缺乏护理知识与技能,94%的患者亲属希望医务人员传授健康知识,对健康知识的需求侧重于安全护理、疾病症状、沟通方法、用药指导、疾病预防及康复知识、日常生活护理指导等。92%的亲属希望提供个别指导,83%的亲属选择提供科普手册。出院后健康教育方式调查发现,78%的亲属选择护士家访,63%选择电话咨询。结论精神分裂症患者亲属多采用消极应对的方式,而较少采用积极应对的方式,其心理健康状况较差,且与应对方式密切相关。     

Stress,burnout, and job dissatisfaction in mental health workers

As the industrial world has transformed toward a service economy, a particular interest has developed in mental health problems at the workplace. The risk for burnout is significantly increased in certain occupations, notably for health care workers. Beyond the effects of an extensive workload, many working hours, or long night shifts, the medical field has specific stressors. Physicians work in emotionally demanding environments with patients, families, or other medical staff. They must make quick decisions while faced with a quite frequent information overload. All of these stressors have to be weighed against a rapidly changing organizational context within medicine. Today, economics objectives have priority over medical values in health care. In principal, mental health workers should experience similar work stressors and the same contextual factors as health professionals from other medical disciplines. However, several studies have identified stressors that are unique to the psychiatric profession. These challenges range from the stigma of this profession, to particularly demanding relationships with patients and difficult interactions with other mental health professionals as part of multidisciplinary teams to personal threats from violent patients. Other sources of stress are a lack of positive feedback, low pay, and a poor work environment. Finally, patient suicide is a major stressor, upon which a majority of mental health workers report post-traumatic stress symptoms.

     

伴危险行为精神疾病患者家属心理压力和应对方式的调查

目的：调查伴危险行为精神疾病患者家属的心理压力状况和应对方式。方法选取2014年5月-12月在广州市民政局精神病院住院或门诊治疗的符合《国际疾病分类(第10版)》(ICD-10)诊断标准、存有危险行为精神疾病患者的家属50名,采用一般情况调查表、生活事件量表(LES)、特质应对方式问卷(TCSQ)和压力感受量表(PSS)对家属进行调查。结果有16名(32%)家属存在健康危险性;不同病程、住院次数的患者其家属TCSQ积极应对评分差异有统计学意义(P<0.05),不同性别患者其家属TCSQ积极应对和消极应对评分差异均有统计学意义(P<0.05)。结论伴危险行为精神疾病患者家属普遍存在着不同程度的心理压力。     

林芝地区精神卫生工作者精神卫生知识知晓率及其对精神疾病的态度

目的了解西藏自治区林芝地区精神卫生工作者的精神卫生知识知晓率现状及其对精神疾病的态度,为提高后续有针对性的援藏工作提供参考。方法采用方便抽样方法抽取了林芝108名精神卫生工作人员,进行精神卫生知识问卷和精神疾病相关态度问卷调查。结果调查对象精神卫生知识总体知晓率为74.03%,年龄越大、有参加过精神/心理方面讲座的人员精神卫生知识问卷得分越高(β=0.261、0.220,P均0.05);精神疾病相关态度问卷总体得分为(45.11±5.21)分,其中有10个条目持正向态度的人员比例接近或高于50%。结论林芝地区精神卫生工作者对精神疾病的包容度较好,但精神卫生知识知晓率仍有待提高。     

北京城区精神分裂症家属经济负担与生存质量

目的：了解精神分裂症家属的经济负担与生存质量的关系。方法：对来自北京市东城区的172位社区精神分裂症家属进行了一般资料,疾病家庭负担量表及世界卫生组织生存质量测定量表简表的调查,对经济负担和生存质量进行相关性分析,并按照不同医疗付费方式进行分组,比较各组间经济负担和生存质量的差异。结果：精神分裂症家属经济负担评分与生存质量总分、生理领域、环境领域评分呈负相关（P〈0.01）;自费医疗比公费医疗经济负担大（P〈0.05）;不同医疗付费方式的精神分裂症家属生存质量总分及其4个领域总体差异无显著性（P〉0.05）。结论：社区精神分裂症家属的经济负担越重,生存质量越低,应采取相应干预措施提高精神分裂症患者家属的生存质量。     

老年期痴呆患者亲属的心理健康状况

目的探讨老年期痴呆患者亲属的心理健康状况。方法应用症状自评量表(SCL-90)、社会支持评定量表(SSRS)、防御方式问卷(DSQ)评定了71例老年期痴呆患者亲属(研究组)并与80例健康人(对照组)进行比较。结果老年期痴呆亲属SCL-90总分(t=6.970,P<0.001)、躯体化(t=2.876,P=0.005)、抑郁(t=2.696,P=0.008)及焦虑(t=2.736,P=0.007)因子分高于对照组。防御方式以不成熟(t=7.394,P<0.001)及中间型防御方式(t=3.143,P=0.002)为主。多元逐步回归分析显示不成熟防御因子分、躯体疾病、对支持的利用度对SCL-90总分影响大。结论老年期痴呆患者亲属存在心理健康问题且与其不成熟防御方式、对支持的利用度低及患者躯体疾病有关。     

重症肌无力患者和家属的健康素养对健康教育的影响

目的通过测评重症肌无力(MG)患者及家属的健康素养,分析影响健康素养的因素以及健康素养对患者和家属掌握MG健康教育内容的意义。方法纳入106例MG患者及101名家属,采用国际公认的健康素养问卷测评他们的健康素养。采用自行设计的MG健康教育内容,随机对被调查者采用医生讲述或患者自行阅读的宣教方式,采用相应的问卷评价患者和家属对健康教育内容的掌握情况。采用独立样本t检验、秩和检验和卡方检验进行单因素分析,采用Logistic回归进行多因素分析。结果患者和家属健康素养为优的比例无统计学差异(P>0.05)。患者和家属健康素养优者中教育程度高者比例均高于健康素养差者(P<0.05,P<0.01)。患者中健康教育得分高的比例高于家属(P<0.01)。患者健康教育得分高者中年轻者比例,家属健康教育得分高者中年轻者和教育程度高者比例均高于健康教育得分低者(均P<0.01)。多因素分析发现,教育程度是影响患者(OR=3.12,P=0.045)和家属(OR=8.82,P=0.001)健康素养的独立影响因素,患者中年龄(OR=7.68,P=0.001)而家属中教育程度(OR=3.25,P=0.013)是健康教育得分的独立影响因素。结论教育程度既是MG患者和家属健康素养的决定因素又是健康教育效果的重要影响因素,年龄也是健康教育效果的重要影响因素,在制定个体化的MG教育方案时需要考虑。     

Helping older adults to help themselves: the role of mental health literacy in family members

Objectives: Family members may play an important role in the health and well-being of older adults. However, little is known about the factors that influence the likelihood of family members supporting older relatives to seek help from mental health professionals for mental health concerns. Mental health literacy is associated with people's help-seeking intentions regarding their own mental health concerns, and some studies have suggested it may play a role in help-seeking on behalf of others. The purpose of this study was to investigate whether mental health literacy is associated with adults’ likelihood of supporting an older relative to seek professional help for mental health concerns.

Method: Two hundred and sixty-three participants completed a measure of mental health literacy and responded to a hypothetical scenario by indicating their likelihood of supporting an older relative experiencing mental health problems to seek help from various sources.

Results: Mental health literacy was positively associated with intentions to support older relative's help-seeking.

Conclusions: Interventions to increase the mental health literacy of the relatives of older adults may lead to additional support for older adults’ help-seeking for mental health concerns.